Paper short abstract:

This study uses aid worker interviews to critically examine the social life and the consequences of a protocol: the case definition for Ebola used during the 2014 epidemic. It examines the construction of such protocols and their use within events in which knowledge is uncertain and risk great.

Paper long abstract:

This study examines the social life and consequences of a particular biomedical technology: the clinical case definition for Ebola, a diagnostic protocol used for making decisions about quarantine during the 2014 epidemic, when prompt diagnostic testing was impossible. As a result of this guideline, many women who experienced common complications of pregnancy met criteria for suspected Ebola infection and were quarantined, a practice that caused dramatic delay in treatment and often resulted in the otherwise preventable deaths of these patients and their infants. Using semi-structured interviews with aid workers caring for women who were pregnant and suspected of having Ebola in Sierra Leone, as well as medical literature, this paper explores aid provider interactions with the protocol. Thinking with a clinical protocol functioned to mediate significant tensions inherent to the practice of medicine, including tensions between provider responsibilities to patient and society, certainty and uncertainty, and different ways of medically knowing. Further, although protocols acted as "technologies of certainty," they were based not only on evidence, but were culturally constructed based on a shared medical imaginary. The protocol served as both a rigid guideline and as a fluid cultural object that shifted and was manipulated by providers at different points in the epidemic. This paper explores the emergence and pliability of the medical protocol in the context of epidemics, fraught as they are with both extreme uncertainty and risk.